反向全肩关节置换术（RTSA）与切开复位内固定术（ORIF）治疗移位的三部分或四部分肱骨近端骨折：一项系统评价和荟萃分析
Reverse total shoulder arthroplasty (RTSA) versus open reduction and internal fixation (ORIF) for displaced three-part or four-part proximal humeral fractures: a systematic review and meta-analysis.
作者信息
Suroto Heri, De Vega Brigita, Deapsari Fani, Prajasari Tabita, Wibowo Pramono Ari, Samijo Steven K
机构信息
Department of Orthopaedics & Traumatology, Dr. Soetomo General Hospital / Universitas Airlangga, Surabaya, Indonesia.
These authors contributed equally to this work.
出版信息
EFORT Open Rev. 2021 Oct 19;6(10):941-955. doi: 10.1302/2058-5241.6.210049. eCollection 2021 Oct.
Despite rapid medical technology development, various challenges exist in three- and four-part proximal humeral fracture (PHF) management. This condition has led to a notably increased use of the reverse total shoulder arthroplasty (RTSA); however, open reduction and internal fixation (ORIF) is still the most widely performed procedure. Thus, these two modalities are crucial and require further discussion. We aim to compare the outcomes of three- or four-part PHF surgeries using ORIF and RTSA based on direct/head-to-head comparative studies.We conducted a systematic review and meta-analysis based on the Cochrane handbook and PRISMA guidelines. We searched MEDLINE (PubMed), Embase (Ovid), and CENTRAL (Cochrane Library) from inception to October 2020. Our protocol was registered at PROSPERO (registration number CRD42020214681). We assessed the individual study risk of bias using ROB 2 and ROBINS-I tools, then appraised our evidence using the GRADE approach.Six head-to-head comparative studies were included, comprising one RCT and five retrospective case-control studies. We found that RTSA significantly improved forward flexion but was comparable to ORIF in abduction (p = 0.03 and p = 0.47, respectively) and more inferior in external rotation (p < 0.0001). Moreover, RTSA improved the overall Constant-Murley score, but the difference was not significant (p = 0.22). Interestingly, RTSA increased complications (by 42%) but reduced the revision surgery rates (by 63%) compared to ORIF (p = 0.04 and p = 0.02, respectively).RTSA is recommended to treat patients aged 65 years or older with a three- or four-part PHF. Compared to ORIF, RTSA resulted in better forward flexion and Constant-Murley score, equal abduction, less external rotation, increased complications but fewer revision surgeries. Cite this article: 2021;6:941-955. DOI: 10.1302/2058-5241.6.210049.
尽管医学技术迅速发展，但在三部分和四部分肱骨近端骨折（PHF）的治疗中仍存在各种挑战。这种情况导致反向全肩关节置换术（RTSA）的使用显著增加；然而，切开复位内固定术（ORIF）仍是最广泛实施的手术。因此，这两种方式至关重要，需要进一步探讨。我们旨在基于直接/头对头比较研究，比较使用ORIF和RTSA治疗三部分或四部分PHF手术的结果。
我们根据Cochrane手册和PRISMA指南进行了系统评价和荟萃分析。我们检索了从创刊到2020年10月的MEDLINE（PubMed）、Embase（Ovid）和CENTRAL（Cochrane图书馆）。我们的方案已在PROSPERO注册（注册号CRD42020214681）。我们使用ROB 2和ROBINS - I工具评估了个体研究的偏倚风险，然后使用GRADE方法评估了我们的证据。
纳入了六项头对头比较研究，包括一项随机对照试验和五项回顾性病例对照研究。我们发现，RTSA显著改善了前屈，但在外展方面与ORIF相当（分别为p = 0.03和p = 0.47），在外旋方面更差（p < 0.0001）。此外，RTSA改善了总体Constant - Murley评分，但差异不显著（p = 0.22）。有趣的是，与ORIF相比，RTSA增加了并发症（增加了42%），但降低了翻修手术率（降低了63%）（分别为p = 0.04和p = 0.02）。
建议使用RTSA治疗65岁及以上的三部分或四部分PHF患者。与ORIF相比，RTSA导致更好的前屈和Constant - Murley评分、相等的外展、更少的外旋、更多的并发症但更少的翻修手术。引用本文：2021；6：941 - 955。DOI：10.1302/2058 - 5241.6.210049。
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